Symphysiotomy injustice requires lifting of legal bar

OPINION:A lobby group wants the statute of limitations to be temporarily lifted for survivors of what were covert, unnecessary and injurious operations

A YOUNG, healthy woman expecting her second child, and a repeat Caesarean section, was admitted to a Dublin hospital in 1967. Operated upon 24 hours later, she was discharged after nine days, unable to walk. She now suffers from some of symphysiotomy’s known side-effects: chronic pain, a “crippled” back and incontinence.

A cruel and high-risk procedure, symphysiotomy – an operation to open a woman’s pelvis during difficult childbirth – severs the symphysis pubis, while pubiotomy (a variant) sunders the pubic bones.

An estimated 1,500 of these discredited operations were performed here between 1942 and 2005, mostly in Catholic teaching hospitals, but also in the Rotunda in Dublin. About 200 women survive today, many of them disabled. Symphysiotomy ruined lives and brought physical, emotional and sexual devastation. Long shunned internationally by doctors due to its dangers, symphysiotomy was revived in 1944 at the National Maternity Hospital (NMH) to replace Caesarean section in selected cases. Personal beliefs and medical ambition drove the Dublin experiment, which intensified at the International Missionary Training Hospital in Drogheda.

A draft report on symphysiotomy by Prof Oonagh Walsh under contract to the Department of Health has found only those symphysiotomies performed post-Caesarean section were wrong. This conclusion rests largely on the following findings:

That symphysiotomy in the 1940s “was considered to be the most suitable thing to do in order to obey the laws of the time. The law between 1944 and 1984 was very much influenced by the teachings of the Catholic Church . . .”;

That “symphysiotomy was a safer way of dealing with difficult births than Caesarean section in the 1940s and 1950s”;

That “symphysiotomy was used mostly in emergencies”.

Survivors of Symphysiotomy (SoS) believes these findings, which are supported by the Institute of Obstetricians and Gynaecologists (IOG), are wrong. These operations were not driven by medical necessity. The surgery was exhumed at the NMH to treat cases of pelvic disproportion that in other Irish hospitals were managed by Caesarean section.

The revivalists were determined to control women’s reproductive health.

They viewed symphysiotomy (wrongly) as a gateway to childbearing without limitation, seeing Caesarean section – the norm for difficult births – as morally hazardous, capping family size and leading to sterilisation and contraception. Symphysiotomy was promoted as permanently widening the pelvis, enabling an unlimited number of vaginal deliveries, whereas four C-sections was widely regarded as the maximum for safety.

Training was also a driver: symphysiotomy was an operation that needed neither theatre nor electricity. Hospitals that aspired to become international teaching centres in the 1940s recognised the surgery’s potential for students from Africa and India.

Ireland was the only country in the developed world to practise this discarded surgery as a procedure of choice in the 1940s. No laws and no ethos forced a doctor to sever a woman’s pelvis in childbirth. The theory that symphysiotomy was “safer” than Caesarean section in the 1940s and 1950s, first suggested by the IOG (letter from the chairman to the chief medical officer, May 4th, 2001), is baseless.

Survivors do not accept symphysiotomy was “safer” than Caesarean section, whose sequels did not include walking difficulties, chronic pain or depression. While the Walsh report states that “fewer mothers and babies died as a result of symphysiotomy”, its statistical tables giving maternal and foetal deaths from symphysiotomy and Caesarean are flawed: they do not compare like with like.

Symphysiotomy was aimed at young, healthy mothers, while Caesarean was carried out on all patients, including those with heart disease. Even at face value, these tables yield rates that show no worthwhile difference in mortality for mothers or babies.

Survivor testimony, hospital reports and medical records belie the theory (also suggested in the IOG’s letter) that symphysiotomy was used mostly in emergencies.

Reports from Lourdes hospital in Drogheda detail the long hours spent by victims in labour before and after surgery. Symphysiotomy did not deliver babies, mothers did, and those unable to do so – through an unhinged pelvis – were delivered by Caesarean section. This is the horror the authorities have tried to hide since Dr Jacqueline Morrissey exposed the latter-day practice of symphysiotomy in this newspaper in 1999.

Unable to persuade the department to run an inquiry in 2010, SoS also failed to convince the IOG of the need to quantify members’ injuries and experiences. The terms of reference drawn up by the department for the draft Walsh report (which resembled terms written by the IOG in 2010), excluded survivors from contributing to what is known about this surgery, though a departmental consultation process took place following publication of the draft report.

SoS ran its own independent consultation process and made a lengthy submission on the Walsh report, which included many individual testimonies contradicting the draft report’s conclusions.

The finding that only Caesarean symphysiotomies were wrong suggests that the remainder, an estimated 97 per cent, were right. So, a small ex gratia payment for pain and suffering, the regrettable complications of an acceptable operation – with no admission of wrongdoing – is all that most survivors can expect from “redress”.

SoS has called for the temporary lifting of the statute of limitations for survivors. These were covert, involuntary, unnecessary and injurious operations. The State turned a blind eye for half a century. Three, four or five decades elapsed before women understood their pelves had been broken gratuitously, yet they are now vulnerable to arguments over delay.

The case taken by Olivia Kearney, who was 18 when a symphysiotomy was carried out on her in 1969 and whose claim for damages was upheld by the Supreme Court in July, was initially dismissed on the grounds of delay. While that appeal succeeded, the case was allowed to proceed only on narrow grounds and the appeal took five years to be heard. But time is not on the survivors’ side: many are in their 70s and 80s.

Lifting the statute bar would obviate procedural battles and ensure unfettered access for survivors to the courts – the only forum for truth and justice that is not under the control or influence of the Department of Health, which has allowed itself to be captured by the IOG on this abusive surgery for over a decade.

Marie O’Connor is chairwoman of Survivors of Symphysiotomy (SoS) and author of Bodily Harm: Symphysiotomy and Pubiotomy in Ireland 1944-92

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